Individual
KERI WIECZERZAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
80 JEFFERSON ST, HARTFORD, CT 06106-5035
(860) 972-5022
Mailing address
51 CHURCH ST, MYSTIC, CT 06355-2745
(973) 349-9314
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
04/03/2020
Last updated
05/06/2024
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